lifestyle change and CAD

the american heart association published a position paper focusing on lifestyle interventions to prevent heart disease (see cad lifestyle change circulation 2103 in dropbox, or go to  http://circ.ahajournals.org/content/early/2013/10/07/01.cir.0000435173.25936.e1.citation ).  they note:

    -- there is abundant evidence that the risk of heart disease is much lower in those with better cardiovascular health metrics (nonsmoking, good diet, physical activity, normal BMI, normal BP, optimal lipids and normal fasting glucose): 78% less heart disease over 5.8 years in those with 5 or more of the above compared to those with none, with similar numbers in longer term studies
    --younger adults with healthy behaviors track to having lower biological risk as they age.
    --those with initially poorer health behaviors who can change them do better clinically. 
    --health care providers, even with brief interventions, are able to help patients quit smoking, improve their diets, and increase physical activity. 
    --on a public health scale, these interventions would not only save lots of lives but reduce costs dramatically

but in order to do this:
    --we need to increase the focus on high-value preventive and chronic care and promote healthier behaviors, which requires
            --expanded health care coverage (so people can be part of the health care system)
            --better reimbursement for these interventions (currently, as we know only too well, it is really hard to do this and take care of all the chronic medical problems and all the array of social issues in 15 minutes)  and better reimbursement to primary care would allow for more time with patients.
            --more training for providers in counseling skills (eg motivational interviewing, patient-centered care). 
            --team approach may also help a lot with this, integrating other health professionals, as well as interfacing with commmunity resources to reinforce the message and provide concrete support (biking trails, farmers' markets...)

so, all in all, i think this represents a good call-to-action to prevent heart disease (and lots of other diseases as well, but this is from the am heart assn) which focuses on both the specific clinical interaction between the provider and patient and the more global public health imperat

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